Artifacts in Nuclear Medicine with Identifying and resolving artifacts.
Chronic diarrhoea in children
1. CHRONIC DIARRHOEA
Dr. Virendra Kumar Gupta
Assistant Professor
Department Of Pediatric Gastroentero-hepatology &
Liver Transplantation
NIMS Medical College & Hospital , Jaipur
2. DIARRHOEA
Diarrhoea defined as excessive loss of fluid and
electrolyte in stool.
For infants stool output >10 ml/kg/24 hr and
>200g/24hr for older children.
When there is an in frequency, volume or liquidity
(Recent change in consistency) of the bowel
movement relative to the usual habit of each individual
Nelson Textbook of Pediatrics, 20th ed
3. • Acute diarrhea
Duration <2 wks, usually of infectious origin
• Prolonged diarrhea
Diarrhea of duration 7-14 days of presumed infectious
etiology. It may be an indicator for children with a high risk
of progression to Persistent diarrhea
• Chronic diarrhea
Diarrhea of more than 2 weeks duration.
• Dysentry
Bloody diarrhea, visible blood and mucus present.
Nelson Textbook of Pediatrics, 20th ed
DEFINITIONS
4. Persistent diarrhea
Persistent diarrhea (PD) is an episode of diarrhea of
presumed infectious etiology, which starts acutely but
lasts for more than 14 days, and excludes chronic or
recurrent diarrheal disorders such as tropical sprue,
gluten sensitive enteropathy or other hereditary
disorders[WHO] (INDIAN PEDIATRICS, JAN 2011)
passage of >=3 watery stools per day for >2 weeks in
a child who either fails to gain weight or loses
weight.(ESPGHAN)
8. Secretory causes
Derangements in fluid and electrolyte transport
across entero colonic mucosa
Watery, large volume fecal output, painless and
persits with fasting
1)medications—ethanol,laxatives
2)bowel resection,mucosal d/s,enterocolic
resection—idiopathic secretory diarrhoea
3)hormones- serotonin,prostaglandins,kinins
4)congenital defects in Fe absorption
15. Proper history and physical examination very
important
HISTORY—onset,duration,pattern,aggrevating and
relieving factors etc
wt.loss,pain,exposures(travel,medications etc)
.FAMILY HISTORY—ibd,sprue
Approach To Patient
16. PHYSICAL EXAMINATION
-- anemia,edema,clubbing(features of
malabsorption,IBD)
--muco cutaneous manifestations of systemic
d/s(dermatitis herpetiformis,erythema
nodosum,oral ulcers etc)
--abdominal mass or tenderness
--abnormalities of rectal mucosa,rectal defects
17. Diagnostic evaluation directed by a careful history
and physical examination
If not revealing triage tests required to direct the
choice of complex investigations
18.
19.
20. Traetment
Curative,suppressive,empirical
1)curative—antibiotic for whipples
d/s,discontinuation of drug
2)suppressive—elimination of dietry lactose,PPI for
gastrinoma,pancreatic enzyme replacement
3)emperical—mild
opiates(loperamide),clonidine,fluid and electrolyte
replition